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Long-Term Planning

Elliott_for_webThere are steps you can take before treatment to manage certain treatment-associated side effects. Some of these steps may minimize long-term complications caused by side effects. You should first meet with the cancer care team and discuss potential side effects and recommendations for managing them.

Prophylactic fluoride teeth treatment

If your loved one must undergo radiation therapy or chemoradiation therapy, he or she will be at higher risk for developing cavities, a problem attributed to decreased salivation.1Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225. Prophylactic fluoride treatment is recommended to protect teeth during and after radiation treatment.2, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.3, Horiot JC, Schraub S, Bone MC, et al. Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol. 1983 Aug;1(1):77-82.4Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6. Encourage your loved one to consider making a dental appointment for fluoride treatment if radiation is part of your loved one’s treatment plan.

Consult a registered nutritionist

Many treatment-associated side effects, such as severe mucositis or nausea and vomiting, can impair the desire to eat. In addition, some treatments can impair swallowing. Therefore, prior to the treatment, a nutritionist may provide recommendations specific to the treatment, such as foods to avoid and strategies to implement in case there are problems obtaining adequate nutrition.5Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Your loved one’s nutritionist should provide strategies as to how to eat if certain side effects occur.

Consult a speech/swallowing therapist

People who receive radiation or chemoradiation therapy often develop complications in swallowing.6Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.

Researchers found that 25 percent of people with oropharyngeal cancer did not have the ability to functionally swallow three months after chemoradiation therapy. Moreover, 61 percent of the people who had chemoradiation therapy did not have a normal diet.6Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.

What steps can maximize the ability to swallow after radiation or chemoradiation therapy? If radiation is part of the treatment plan, the following recommendations can help:

  • The speech/swallowing therapist may do an evaluation of your loved one’s swallowing and speech before, during and after radiation or chemoradiation therapy.5, Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.6Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.
  • Attend speech or swallowing therapy sessions if your therapist finds a deficit and recommends that you learn exercises.6, Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.7Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006 Jun 10;24(17):2636-43.
  • Practice the recommended exercises.Researchers found that more patients maintained their ability to swallow if they did swallowing exercises before radiation therapy versus after radiation therapy.7, Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006 Jun 10;24(17):2636-43.8, Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006 Jun;116(6):883-6.9Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008 Jan;118(1):39-43.
  • Because decreased salivation will be a likely side effect, chew sugar-free gum, which can promote salivation and minimize the risk of developing cavities.7Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006 Jun 10;24(17):2636-43.
  • Depending on the recommendation of the cancer care team, patients may undergo periodic speech and swallowing evaluations post-therapy.5Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Begin an exercise program

Most patients will experience cancer-related fatigue during and after treatment, and for one in three people with cancer, the fatigue may be so severe they will not be able to participate in their usual activities.10, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.11, Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.12, Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.13Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10. Exercise has been found to decrease cancer-related fatigue, so your loved one may want to consider starting an exercise program prior to the initiation of therapy.14, Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.15, Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E.Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.16, Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.17Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

Find a support group

People report experiencing stress and anxiety during the cancer journey. Moreover, one in three people experience moderate depression up to 10 years after receiving radiation therapy.18Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):964-71. Participating in patient support groups has been associated with improved quality of life.19Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100. You and your loved one may want to consider identifying and participating in a support group.

Making those follow-up visits is very important. When your doctor tells you that you need a test, you go and get the test done.Debra R. (mucoepidermoid carcinoma of the palate survivor)

References

1 Vissink A, Burlage FR, Spjkervet FKL, Jansma J, Coppes RP. Prevention and treatment of the consequences of head and neck radiotherapy. Crit Rev Oral Biol Med. 2003;14(3):213-225.

2 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.

3 Horiot JC, Schraub S, Bone MC, et al. Dental preservation in patients irradiated for head and neck tumours: A 10-year experience with topical fluoride and a randomized trial between two fluoridation methods. Radiother Oncol. 1983 Aug;1(1):77-82.

4 Zlotolow IM. Clinical manifestations of head and neck irradiation. Compend Contin Educ Dent. 1997;18(2 Spec No):51-6.

5 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

6 Logemann JA, Pauloski BR, Rademaker AW, et al. Swallowing disorders in the first year after radiation and chemoradiation. Head Neck. 2008 Feb;30(2):148-58.

7 Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol. 2006 Jun 10;24(17):2636-43.

8 Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope. 2006 Jun;116(6):883-6.

9 Carroll WR, Locher JL, Canon CL, Bohannon IA, McColloch NL, Magnuson JS. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope. 2008 Jan;118(1):39-43.

10 Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

11 Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.

12 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

13 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

14 Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.

15 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E.Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.

16 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

17 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

18 Terrell JE, Fisher SG, Wolf GT. Long-term quality of life after treatment of laryngeal cancer. The Veterans Affairs Laryngeal Cancer Study Group. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):964-71.

19 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns. 1998 Oct;35(2):89-100.